Increasing number of stroke centers, advances in treatment save more patients in Vietnam

As of now, the whole country hosts around 110 stroke centers, up from only one at 115 People’s Hospital in Ho Chi Minh City in 2006, Assoc. Prof. Dr. Nguyen Huy Thang, Chair of Cerebrovascular Disease Department at 115 People’s Hospital and President of HCMC Stroke Association, told VnExpress on the sidelines of “Angels Academy: Stroke Multi-disciplinary” meeting held on June 25 in the city.

“That is the great effort of individuals, Vietnam and HCMC stroke associations,” Thang said.

Training conference on stroke treatment co-held by Angles was live streamed online to stroke doctors in ASEAN, South Korea and Australia.

Moreover, the associations have worked with Angels Initiative, launched by Boehringer Ingelheim and endorsed by the European Stroke Organization and the World Stroke Organization to improve care for people who have just suffered a stroke, to organize training courses for Vietnamese doctors, nurses and paramedic focused on treatment and care of stroke patients.

The initiative works toward developing more and better stroke ready centers, and to build and develop efficient regional referral networks where primary, comprehensive centers and EMS work together to provide patients the best care.

As a result, stroke center doctors and nurses have applied more advances in stroke treatment that meet international standards to save more patients and minimize long-term disabilities caused by stroke, Thang said.

These advances include the use of recombinant tissue plasminogen activator (rtPA) which has been the standard of care for treatment of acute ischemic stroke and mechanical thrombectomy – the type of minimally-invasive procedure in which an interventional radiologist uses specialized equipment to remove a clot from a patient’s artery.

A/Prof. Nguyen Huy Thang (the second position from left) and experts discussed advances in stroke treatment at the conference.

Moreover, several hospitals including 115 People’s Hospital and Gia An 115 Hospital in HCMC, Phu Tho Province General Hospital … and Quang Ninh Province General Hospital have used the RAPID Artificial Intelligence framework combining deep learning, machine learning and expert feature extraction. The RAPID artificial intelligence framework helps to quantify brain lesions and extend the window of potential stroke intervention from six hours after onset to up to 24 hours, for patients with salvageable brain tissue. RAPID provides physicians with fast, fully automated, and easy-to-interpret imaging that facilitates clinical decision-making around strokes.

In the 2007-2010 period, nearly 100-200 acute stroke patients got treatment, Thang said, adding that the figure has now increased to around 10,000. “This proves the great efforts of doctors and nurses in helping stroke patients access the best treatment that increases chances for them to not suffer from long-term disabilities and return to normal life.”

“We know that 70 percent of stroke patients cannot function as before,” he added.

To improve quality and effectiveness in treatment and care of stroke patients at stroke centers, nurses also play a vital role. Speaking at “Angels Academy: Stroke Multi-disciplinary” meeting, Do Thi Hai Van, head nurse of Bach Mai Stroke Center, said that they assist doctors in taking care of stroke patients to prevent complications including paralysis, difficulty swallowing or talking, balance problems, dizziness, memory loss, difficulty controlling emotions, depression, pain, and changes in behavior.

They are trained to early recognize signs of complication like dangerous and life-threatening pulmonary embolism that arises from venous thromboembolism, also known as blood clots, developing in a paralyzed lower extremity after a stroke. They then report to doctors to treat and save these patients in time, Van said.

During the treatment process and before being discharged from hospital, they spend time on educating patients and their relatives on rapid recovery, she said, adding that moreover, nurses also talk to patients.

According to the World Stroke Organization, stroke remains the second-leading cause of death and the third-leading cause of death and disability combined in the world.

In Vietnam alone, 200,000 new stroke cases are recorded each year, the Ministry of Health said, adding that strokes kill 11,000 people.

Telemedicine in stroke treatment

“Angels Academy: Stroke Multi-disciplinary” meeting also highlighted the role of telemedicine that can help stroke patients especially in remote areas without stroke centers to access treatment more quickly and reduce the number of fake strokes. Early triage by a stroke consultant can potentially speed up ‘door-to-needle’ times once patients are at hospital by enabling better preparation.

At the meeting, Dr. David Hargroves, consultant stroke physician at East Kent Hospital University Foundation Trust in England, shared experiences and results in setting up a telemedicine pilot between South East Coast Ambulance Foundation Trust and East Kent Hospitals University Foundation Trust in November 2018 to test the feasibility of pre-hospital direct calls between ambulance clinicians and hospital doctors in order to triage patients who are FAST+ (facial drooping, arm weakness, speech difficulties and time to call emergency services).

“Telephone triage assessment between stroke specialist and ambulance crew improve sensitivity and specificity of triage to support time critical access to thrombolysis and thrombectomy,” he said.

Prof. Ken Butcher, director of Clinical Neurosciences at the Prince of Wales Clinical School at the University of New South Wales, introduced tele-stroke services that bring sub-specialist stroke care to rural and remote hospital settings using tele-health technology.

Prof. Kenneth Butcher shared the role of telemedicine in stroke consultancy and treatment.

The service offers people living in regional and rural areas increased access to life-saving stroke diagnosis and treatment. This is done by connecting local doctors to stroke specialists, via video consultation in the emergency department.

“This service is not costly and could be suitable in Asia,” he said.

The meeting focused on improving from better to best: how we can work together to optimize stroke systems and networks, to develop effective stroke networks and telestroke programs; and to reinforce the importance of post-acute care in improving patient outcomes. It was held as a hybrid meeting in HCMC’s Sheraton Saigon Hotel and live streamed online to stroke teams across the ASEAN region, South Korea, and Australia.

Klara Le
(Photo: Huy Hoang)